High Degree Of Heterogeneity Research Articles

The South China Sea International Disputes with the ASEAN Area (in International Maritime Law)

In history, the sea has been shown to have had various functions, including as a source of food for mankind, as a trade highway, as a means of conquest, as a place for battles, as a place for fun and recreation, and as a means of unifying or separating nations. nation. As one of the regions with a high degree of heterogeneity, the Asia Pacific region is often considered a region that is very vulnerable to conflict on the basis of a fragile regional balance. The purpose of this study is to find out that one of the territorial conflicts in the Asia Pacific is the South China Sea conflict which involves several countries including China, Taiwan, the Philippines, Vietnam, Malaysia and Brunei Darussalam. This research uses a normative approach in accordance with international maritime regulations, especially UNCLOS and the UN Arbitration Council. The results of this study indicate that she said the South China Sea entered a new chapter by submitting a dispute over the issue of territorial claims to the Arbitration Court in The Hague, Netherlands. The Philippines in January 2013 has officially brought the territorial dispute in the South China Sea to the international arbitration body. Political disputes have been stopped and entered a new phase, namely legal settlement. The issue that arises is whether legal settlement can be the key answer to this territorial dispute, then whether legal settlement can create justice for the disputing countries. Furthermore, whether a legal settlement can dampen and create stability and security in the region. It may be very far if a legal settlement can fulfill some of the questions above.

Examining heterogeneity of education intervention effects using quantile mixed models: a re-analysis of a cluster-randomized controlled trial of a fluency-based mathematics intervention

ABSTRACT Traditionally, cluster randomized controlled trials are analyzed with the average intervention effect of interest. However, in populations that contain higher degrees of heterogeneity or variation may differ across different values of a covariate, which may not be optimal. Within education and social science contexts, exploring the variation in magnitude of treatment effect at different points in the population can indicate where the intervention is most effective rather than assuming an average effect. Data from [Owen, K.L., et al., 2021. Implementation support improves outcomes of a fluency-based mathematics strategy: A cluster-randomized controlled trial. Journal of research on educational effectiveness, 14 (3), 523–542.] were reanalyzed using three modeling approaches: conditional mean-modeling reporting the average treatment effect using linear mixed models, and two quantile regression-based methods. Quantile regressions report the quantile treatment effects at different percentiles: 10th, 25th, 50th, 75th and 90th. For the Quantile approaches, a significant intervention effect in the median to upper quantiles was found and linear quantile mixed model showed improved fit over the other approaches. An improved picture of intervention effects may be apparent using quantile regression methods when analyzing cluster randomized trials that have heterogeneous error variance. In particular, the linear quantile mixed model shows improved model fit allowing a multilevel framework to include random effects. There is considerable scope to extend this framework to incorporate more complex RCT designs.

Utility and limitations of patient-adjusted D-dimer cut-off levels for diagnosis of venous thromboembolism-A systematic review and meta-analysis.

To systematically assess test performance of patient-adapted D-dimer cut-offs for the diagnosis of venous thromboembolism (VTE). Systematic review and analysis of articles published in PubMed, Embase, ClinicalTrials.gov, and Cochrane Library databases. Investigations assessing patient-adjusted D-dimer thresholds for the exclusion of VTE were included. A hierarchical summary receiver operating characteristic model was used to assess diagnostic accuracy. Risk of bias was assessed by Quality Assessment of Diagnostic Accuracy Studies 2 score. A total of 68 studies involving 141,880 patients met the inclusion criteria. The standard cut-off revealed a sensitivity of 0.99 (95% confidence interval [CI] 0.98-0.99) and specificity of 0.23 (95% CI 0.16-0.31). Sensitivity was comparable to the standard cut-off for age-adjustment (0.97 [95% CI 0.96-0.98]) and YEARS algorithm (0.98 [95% CI 0.91-1.00]) but lower for pretest probability (PTP)-adjusted (0.95 [95% CI 0.89-0.98) and COVID-19-adapted thresholds (0.93 [95% CI 0.82-0.98]). Specificity was significantly higher across all adjustment strategies (age: 0.43 [95% CI 0.36-0.50]; PTP: 0.63 [95% CI 0.51-0.73]; YEARS algorithm: 0.65 [95% CI 0.39-0.84]; and COVID-19: 0.51 [95% CI 0.40-0.63]). The YEARS algorithm provided the best negative likelihood ratio (0.03 [95% CI 0.01-0.15]), followed by age-adjusted (both 0.07 [95% CI 0.05-0.09]), PTP (0.08 [95% CI 0.04-0.17), and COVID-19-adjusted thresholds (0.13 [95% CI 0.05-0.32]). This study indicates that adjustment of D-dimer thresholds to patient-specific factors is safe and embodies considerable potential for reduction of imaging. However, robustness, safety, and efficiency vary considerably among different adjustment strategies with a high degree of heterogeneity.

Monocyte heterogeneity in cardiovascular disease.

Monocytes circulate the vasculature at steady state and are recruited to sites of inflammation where they differentiate into macrophages (MФ) to replenish tissue-resident MФ populations and engage in the development of cardiovascular disease (CVD). Monocytes display considerable heterogeneity, currently reflected by a nomenclature based on their expression of cluster of differentiation (CD) 14 and CD16, distinguishing CD14++CD16- classical (cMo), CD14++CD16+ intermediate (intMo) and CD14+CD16++ non-classical (ncMo) monocytes. Several reports point to shifted subset distributions in the context of CVD, with significant association of intMo numbers with atherosclerosis, myocardial infarction, and heart failure. However, clear indications of their causal involvement as well as their predictive value for CVD are lacking. As recent high-parameter cytometry and single-cell RNA sequencing (scRNA-Seq) studies suggest an even higher degree of heterogeneity, better understanding of the functionalities of these subsets is pivotal. Considering their high heterogeneity, surprisingly little is known about functional differences between MФ originating from monocytes belonging to different subsets, and implications thereof for CVD pathogenesis. This paper provides an overview of recent findings on monocyte heterogeneity in the context of homeostasis and disease as well as functional differences between the subsets and their potential to differentiate into MФ, focusing on their role in vessels and the heart. The emerging paradigm of monocyte heterogeneity transcending the current tripartite subset division argues for an updated nomenclature and functional studies to substantiate marker-based subdivision and to clarify subset-specific implications for CVD.

Assessing the Impact of Workforce Nutrition Programmes on Nutrition, Health and Business Outcomes: A Review of the Global Evidence and Future Research Agenda

One in three people globally suffers from at least one form of malnutrition, leading to poor health outcomes and low productivity in the workplace. The workplace offers an important, relatively unexploited opportunity to address malnutrition in all its forms. This narrative literature review aims to understand the impact of workforce nutrition programmes on nutrition, health, and business outcomes, based on high-strength-of-evidence studies. We used PubMed as our primary research database, complemented by Google Scholar, to identify systematic reviews, meta-analyses, and randomised controlled trials published between January 2010 and October 2021. In total, 26 records were included. We found that comprehensive workforce nutrition programmes, including a variety of intervention areas, and/or programmes targeting high-risk categories of workers (overweight/obese or (pre-)diabetic) were more likely to be effective on nutrition, health, and business outcomes. Within comprehensive and targeted programmes, individualised counselling and worksite environmental modifications were often mentioned as the most effective components. However, a high degree of heterogeneity in outcome measures and programme designs made it difficult to draw strong conclusions on the impact of workforce nutrition interventions. Limited evidence was found on business outcomes, longer-term effects of interventions, and programme implementation in LMICs. Therefore, further research is needed to address these evidence gaps.

The efficacy of dance interventions for the activity and participation of individuals with cerebral palsy – a systematic review and meta-analysis

Purpose The aim of this review was to examine the efficacy of dance interventions for individuals with cerebral palsy (CP), measured at any level of the International Classification of Functioning, Disability and Health (ICF). Methods A systematic review and meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search of peer-reviewed articles was performed using six electronic databases. Results Fourteen studies were included in this review, nine of which were also included in the meta-analysis. The meta-analyses yielded a large overall effect for cognitive, motor, and social-emotional function outcomes, with a high degree of heterogeneity between outcome effects, attributable to differences in study design. Conclusion Although recent studies provide support for the acceptance and efficacy of dance interventions for people with CP, the systematic review revealed significant limitations in study design (only 2 randomised control trials). High-quality research that measures outcomes across all dimensions of the ICF, and particularly at the level of participation, are needed to improve the level of empirical support for dance-based interventions.

Risk of Postoperative Venous Thromboembolism After Benign Colorectal Surgery: Systematic Review and Meta-analysis.

Venous thromboembolism is a well-established preventable complication after colectomy. Specific guidance on venous thromboembolism prevention after colectomy for benign disease is limited. This meta-analysis aimed to quantify the venous thromboembolism risk after benign colorectal resection and determine its variability. Following Preferred Reporting Items for Systematic Review and Meta-Analysis and Meta-analysis of Observational Studies in Epidemiology Guidelines (PROSPERO: CRD42021265438), Embase, MEDLINE, and 4 other registered medical literature databases were searched from the database inception to June 21, 2021. Inclusion criteria: randomized controlled trials and large population-based database cohort studies reporting 30-day and 90-day venous thromboembolism rates after benign colorectal resection in patients aged ≥18 years. Exclusion criteria: patients undergoing colorectal cancer or completely endoscopic surgery. Thirty- and 90-day venous thromboembolism incidence rates per 1000 person-years after benign colorectal surgery. Seventeen studies were eligible for meta-analysis reporting on 250,170 patients. Pooled 30-day and 90-day venous thromboembolism incidence rates after benign colorectal resection were 284 (95% CI, 224-360) and 84 (95% CI, 33-218) per 1000 person-years. Stratified by admission type, 30-day venous thromboembolism incidence rates per 1000 person-years were 532 (95% CI, 447-664) for emergency resections and 213 (95% CI, 100-453) for elective colorectal resections. Thirty-day venous thromboembolism incidence rates per 1000 person-years after colectomy were 485 (95% CI, 411-573) for patients with ulcerative colitis, 228 (95% CI, 181-288) for patients with Crohn's disease, and 208 (95% CI, 152-288) for patients with diverticulitis. High degree of heterogeneity was observed within most meta-analyses attributable to large cohorts minimizing within-study variance. Venous thromboembolism rates remain high up to 90 days after colectomy and vary by indication for surgery. Emergency resections compared to elective benign resections have higher rates of postoperative venous thromboembolism. Further studies reporting venous thromboembolism rates by type of benign disease need to stratify rates by admission type to more accurately define venous thromboembolism risk after colectomy. CRD42021265438.

Effects of New Antiepileptic Drugs on Homocysteine in Epileptic Patients: A Systematic Review and Meta-Analysis

Background. Previous studies have reported inconsistent findings regarding the association between elevated plasma homocysteine (Hcy) levels and new antiepileptic drugs (AEDs). In this meta-analysis, we aimed to assess the effects of new AEDs on Hcy. Methods. PubMed, Embase, Cochrane, and Web of Science databases were searched from inception to June 2022 for articles that focused on the effects of new AEDs on Hcy. A meta-analysis was performed using Stata 16.0 software. The results were presented as the mean difference (MD) and corresponding to 95% confidence intervals (CIs) comparing epileptic patients with new AEDs to the control subjects. Results. A total of 11 studies were included in the meta-analysis. Hcy was markedly increased in the new AEDs group compared with the control group (MD = 2.220, 95% CI: 0.596–3.844, P = 0.007 ), with a high degree of heterogeneity (I2 = 99.5%). In the drugs subgroup, the oxcarbazepine (OXC) (MD = 2.30, 95% CI: −1.11–5.72, P = 0.187 ) and lamotrigine (LTG) (MD = 1.14, 95% CI: −0.209–2.482, P < 0.001 ) groups had no significant differences when compared with the control group. The levetiracetam (LEV) (MD = 1.81, 95% CI: 1.03–2.18, P < 0.001 ) and topiramate (TPM) (MD = 6.922, 95% CI: 0.788–13.055, P = 0.027 ) groups were significantly higher than the control group. Conclusions. The new AEDs, especially TPM and LEV, may increase the plasma of Hcy. The role of Hcy in patients with epilepsy who are given TPM and LEV should not be ignored in clinical situations. Patients with epilepsy who also have a high-risk vascular profile are recommended to use OXC and LTG.

Magnetic Resonance Imaging of Mouse Cerebral Cavernomas Reveal Differential Lesion Progression and Variable Permeability to Gadolinium.

Cerebral cavernous malformations, also known as cavernous angiomas, are blood vessel abnormalities comprised of clusters of grossly enlarged and hemorrhage-prone capillaries. The prevalence in the general population, including asymptomatic cases, is estimated to be 0.5%. Some patients develop severe symptoms, including seizures and focal neurological deficits, whereas others remain asymptomatic. The causes of this remarkable presentation heterogeneity within a primarily monogenic disease remain poorly understood. We established a chronic mouse model of cerebral cavernous malformations, induced by postnatal ablation of Krit1 with Pdgfb-CreERT2, and examined lesion progression in these mice with T2-weighted 7T magnetic resonance imaging (MRI). We also established a modified protocol for dynamic contrast-enhanced MRI and produced quantitative maps of gadolinium tracer gadobenate dimeglumine. After terminal imaging, brain slices were stained with antibodies against microglia, astrocytes, and endothelial cells. These mice develop cerebral cavernous malformations lesions gradually over 4 to 5 months of age throughout the brain. Precise volumetric analysis of individual lesions revealed nonmonotonous behavior, with some lesions temporarily growing smaller. However, the cumulative lesional volume invariably increased over time and after about 2 months followed a power trend. Using dynamic contrast-enhanced MRI, we produced quantitative maps of gadolinium in the lesions, indicating a high degree of heterogeneity in lesional permeability. MRI properties of the lesions were correlated with cellular markers for endothelial cells, astrocytes, and microglia. Multivariate comparisons of MRI properties of the lesions with cellular markers for endothelial and glial cells revealed that increased cell density surrounding lesions correlates with stability, whereas denser vasculature within and surrounding the lesions may correlate with high permeability. Our results lay a foundation for better understanding individual lesion properties and provide a comprehensive preclinical platform for testing new drug and gene therapies for controlling cerebral cavernous malformations.

Rock typing of the Miocene Hammam Faraun alluvial fan delta sandstone reservoir using well logs, nuclear magnetic resonance, artificial neural networks, and core analysis, Gulf of Suez, Egypt

The application of integrated methods to evaluate the quality of reservoir rocks is becoming crucial in petroleum geoscience. The Miocene reservoirs in the El Morgan Oil Field consist mainly of sandstones with interbedded dolomitic silts and shales. Based on the pore scale, the sandstone reservoir of Hammam Faraun Member is a heterogeneous reservoir, and this is the main challenge in this oil field that affects both production and exploration activities. In this article, we have integrated the well logs, nuclear magnetic resonance (NMR), artificial neural networks (ANN) and core analysis to better understand these alluvial fan sandstone reservoirs. The petrographic description indicates arkosic sandstone with varied pore types, texture, cement, and sorting. The studied flow and storage capacity for well#1, indicate four rock types with 24 flow units and eleven barriers, which indicates a high degree of heterogeneity. The artificial neural networks (ANN), that is, the K.mod module, were used to enhance the prediction quality and forecast of FZI in the uncored intervals, where the NMR‐calculated permeability acts as a calibration point for the FZI model validation. This study reveals that the FZI is controlled by permeability, which is mostly influenced by pore throat size. The NMR log showed varied free fluid volume with varied capillaries, clay‐bound volumes and minor streaks of tar along the studied unit. The reservoir pores in the study area are residual pores that have undergone mechanical compaction and cementation that reduce porosities, while dissolution enhances the sandstone porosities. Porosity and permeability were significantly reduced in the presence of clays and carbonate minerals, which indicates poor reservoir quality zones in some parts. The primary factor influencing permeability is pore throat size, which is heavily influenced by the depositional environment and subsequent diagenetic processes. The findings of this study could lead to the development of accurate reservoir static models for future exploration and development plans in the studied area and elsewhere in similar depositional settings.

Slow‐release fertilizers using lignin: Challenges and future prospects

AbstractLignin is an integral part of the plant cell wall and is the largest single source of aromatic carbon in the world, which makes it suitable for the production of feed, chemicals, fuels, and biomaterials. Total lignin production is greater than 50 million tons per annum; however, currently, less than 5% of the lignin is being valorized, and 95% is burnt to create steam and power. Burning aromatic carbons produces heat and power, making them low‐value materials. However, the macromolecules of lignin can be modified to use for several industrial applications, such as surfactants, paints, hydrogel, absorbents, and fertilizer. In this review, we provide a systematic and comprehensive summary of the last 10 years of the development of controlled release fertilizer (CRF) from lignin, which is a renewable material. Lignin‐based CRFs are green, environment friendly, and are considered efficient for agricultural use in place of urea and diammonium phosphate. Coating the fertilizer with lignin could increase fertilizer's 20–30 times slower release vis‐à‐vis uncoated fertilizer. However, the structure of lignin varies from one process to another process; it is therefore highly dependent upon the fractionation process and pulping methodologies adopted. A high degree of heterogeneity, complex structure, and low reactivity of the lignin results in an uneven coating, large surface porosity, and cracks in the coatings. The similarity of the lignin can be improved by chemical modifications in its molecule; however, any chemical processing increases the cost of slow‐release fertilizer. © 2023 Society of Industrial Chemistry and John Wiley & Sons Ltd.

Construction and validation of a prognosis signature based on the immune microenvironment in gastric cancer.

Gastric cancer (GC) is an aggressive malignant tumor with a high degree of heterogeneity, and its immune microenvironment is closely associated with tumor growth, development and drug resistance. Therefore, a classification system of gastric cancer based explicitly on the immune microenvironment context might enrich the strategy for gastric cancer prognosis and therapy. A total of 668 GC patients were collected from TCGA-STAD (n = 350), GSE15459 (n = 192), GSE57303 (n = 70) and GSE34942 (n = 56) datasets. Three immune-related subtypes (immunity-H, -M, and -L) were identified by hierarchical cluster analysis based on the ssGSEA score of 29 immune microenvironment-related gene sets. The immune microenvironment-related prognosis signature (IMPS) was constructed via univariate Cox regression, Lasso-Cox regression and multivariate Cox regression, and nomogram model combining IMPS and clinical variables was further constructed by the "rms" package. RT-PCR was applied to validate the expression of 7 IMPS genes between two human GC cell lines (AGS and MKN45) and one normal gastric epithelial cell line (GES-1). The patients classified as immunity-H subtype exhibited highly expressed immune checkpoint and HLA-related genes, with enriched naïve B cells, M1 macrophages and CD8 T cells. We further constructed and validated a 7-gene (CTLA4, CLDN6, EMB, GPR15, ENTPD2, VWF and AKR1B1) prognosis signature, termed as IMPS. The patients with higher IMPS expression were more likely to be associated with higher pathology grade, more advanced TNM stages, higher T and N stage, and higher ratio of death. In addition, the prediction values of the combined nomogram in predicting 1-year (AUC = 0.750), 3-year (AUC = 0.764) and 5-year (AUC = 0.802) OS was higher than IMPS and individual clinical characteristics. The IMPS is a novel prognosis signature associated with the immune microenvironment and clinical characteristics. The IMPS and the combined nomogram model provide a relatively reliable predictive index for predicting the survival outcomes of gastric cancer.

An experiment on the impact of predictive analytics on kidney offers acceptance decisions

Because of the breadth of factors that might affect kidney transplant decisions to accept an organ or wait for another, presumably “better” offer, a high degree of heterogeneity in decision making exists among transplant surgeons and hospitals. These decisions do not typically include objective predictions regarding the future availability of equivalent or better-quality organs or the likelihood of patient death while waiting for another organ. To investigate the impact of displaying such predictions on organ donation decision making, we conducted a statistically designed experiment involving 53 kidney transplant professionals, in which kidney offers were presented via an online application and systematically altered to observe the effects on decision making. We found that providing predictive analytics for time-to-better offers and patient mortality improved decision consensus and decision-maker confidence in their decisions. Providing a visual display of the patient’s mortality slope under accept/reject conditions shortened the time-to-decide but did not have an impact on the decision itself. Presenting the risk of death in a loss frame as opposed to a gain frame improved decision consensus and decision confidence. Patient-specific predictions surrounding future organ offers and mortality may improve decision quality, confidence, and expediency while improving organ utilization and patient outcomes.

N-acetylcysteine efficacy in patients hospitalized with COVID-19 pneumonia: a systematic review and meta-analysis.

N-acetylcysteine (NAC) is a mucolytic agents with anti-inflammatory properties that has been suggested as an adjunctive therapy in patients with COVID-19 pneumonia. We conducted a systematic review and meta-analysis to evaluate available evidence on the possible beneficial effects of NAC on SARS-CoV-2 infection. In September 2022, we conducted a comprehensive search on Pubmed/Medline and Embase on randomized controlled trials (RCTs) and observational studies on NAC in patients with COVID-19 pneumonia. Study selection, data extraction and risk of bias assessment was performed by two independent authors. RCTs and observational studies were analyzed separately. We included 3 RCTs and 5 non-randomized studies on the efficacy of NAC in patients with COVID-19, enrolling 315 and 20826 patients respectively. Regarding in-hospital mortality, the summary effect of all RCTs was OR: 0.85 (95% CI: 0.43 to 1.67, I2=0%) and for non-randomized studies OR: 1.02 (95% CI: 0.47 to 2.23, I2=91%). Need for ICU admission was only reported by 1 RCT (OR: 0.86, 95% CI:0.44-1.69, p=0.66), while all included RCTs reported need for invasive ventilation (OR:0.91, 95% CI:0.54 to 1.53, I2=0). Risk of bias was low for all included RCTs, but certainty of evidence was very low for all outcomes due to serious imprecision and indirectness. The certainty of evidence in the included studies was very low, thus recommendations for clinical practice cannot be yet made. For all hard clinical outcomes point estimates in RCTs are close to the line of no effect, while observational studies have a high degree of heterogeneity with some of them suggesting favorable results in patients receiving NAC. More research is warranted to insure that NAC is both effective and safe in patients with COVID-19 pneumonia.

Psychosomatic health inventory: Basic psychosomatic documentation for quality assurance inpatient care

Objectives: As part of the quality assurance of inpatient treatment, the severity of the disease and the course of therapy must be mapped. However, there is a high degree of heterogeneity in the implementation of basic diagnostics in psychosomatic facilities.There is a lack of scientifically based standardisation in determining the quality of outcomes. Methods: With the help of scientifically established test instruments, a resource-saving basic documentation instrument was developed. Many existing psychometric instruments were checked for test quality, costs and computer-supported application. Results: The Psychosomatic Health Inventory (gi-ps) consists of three basic modules with a total of 63 items: sociodemography, screening and psychosomatic health status.The latter is represented bymeans of construct-based recording on eight scales. Its collection at admission and discharge allows the presentation of the quality of outcomes.The development of a proprietary software solution with LimeSurvey enables the computer-based collection, evaluation, and storage of data. A list of test inventories for confirming diagnoses and predictors has been compiled, which are recommended for use in clinical routine. Discussion: With the gi-ps, a modular basic documentation instrument including the software solution is available to all interested institutions free of charge.

A systematic review of risk factors for mortality among tuberculosis patients in South Africa

BackgroundTuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients.MethodsWe conducted a systematic review of TB research articles published between 2010 and 2018. We searched BioMed Central (BMC), PubMed®, EBSCOhost, Cochrane, and SCOPUS for publications between January 2010 and December 2018. Searches were conducted between August 2019 and October 2019. We included randomised control trials (RCTs), case control, cross sectional, retrospective, and prospective cohort studies where TB mortality was a primary endpoint and effect measure estimates were provided for risk factors for TB mortality during TB treatment. Due to heterogeneity in effect measures and risk factors evaluated, a formal meta-analysis of risk factors for TB mortality was not appropriate. A random effects meta-analysis was used to estimate case fatality ratios (CFRs) for all studies and for specific subgroups so that these could be compared. Quality assessments were performed using the Newcastle-Ottawa scale or the Cochrane Risk of Bias Tool.ResultsWe identified 1995 titles for screening, 24 publications met our inclusion criteria (one cross-sectional study, 2 RCTs, and 21 cohort studies). Twenty-two studies reported on adults (n = 12561) and two were restricted to children < 15 years of age (n = 696). The CFR estimated for all studies was 26.4% (CI 18.1–34.7, n = 13257 ); 37.5% (CI 24.8-50.3, n = 5149) for drug-resistant (DR) TB; 12.5% (CI 1.1–23.9, n = 1935) for drug-susceptible (DS) TB; 15.6% (CI 8.1–23.2, n = 6173) for studies in which drug susceptibility was mixed or not specified; 21.3% (CI 15.3-27.3, n = 7375) for people living with HIV/AIDS (PLHIV); 19.2% (CI 7.7–30.7, n = 1691) in HIV-negative TB patients; and 6.8% (CI 4.9–8.7, n = 696) in paediatric studies. The main risk factors associated with TB mortality were HIV infection, prior TB treatment, DR-TB, and lower body weight at TB diagnosis.ConclusionsIn South Africa, overall mortality during TB treatment remains high, people with DR-TB have an elevated risk of mortality during TB treatment and interventions to mitigate high mortality are needed. In addition, better prospective data on TB mortality are needed, especially amongst vulnerable sub-populations including young children, adolescents, pregnant women, and people with co-morbidities other than HIV. Limitations included a lack of prospective studies and RCTs and a high degree of heterogeneity in risk factors and comparator variables.Systematic review registrationThe systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018108622. This study was funded by the Bill and Melinda Gates Foundation (Investment ID OPP1173131) via the South African TB Think Tank.

The clinical course of untreated CIN2 (HPV16/18+) under active monitoring: A protocol of systematic reviews and meta-analysis.

Cervical cancer (CC) is one of the most prevalent and fatal cancers among women. Nearly all forms of CC are related to HPV, and 70% of invasive CCs are associated with HPV16 and HPV18. A histologically confirmed case of cervical intraepithelial neoplasia (CIN)2 or a more severe histological diagnosis is considered to be the demarcation point for treatment, but overtreatment will increases the risk of preterm birth in subsequent pregnancies. This study will evaluate the progress of CIN2 (progression, persistence, or regression) in HPV16/18+ CIN2 patients who were managed conservatively for 3 months. PubMed, Cochrane Library, China National Knowledge Infrastructure, Cumulative Index for Nursing and Allied Health Literature (CINAHL), and the Excerpta Medica Database will be searched. We will include studies reporting on women with CIN2 and HPV16/18+, conservative treatment for 3 to 60 months with disease outcomes including progression (CIN3 or worse), persistence (CIN2), and regression rates (CIN1 or less). The primary outcome will be the progress of CIN2. Two authors will search the relevant literature, extract the data, and assess the risk of bias. A funnel chart will be used to identify publication or other reporting biases, and the AHRQ guidelines will be used to assess the risk of bias in each included study. The I2 statistic will be used to assess heterogeneity. If there is a high degree of heterogeneity between the studies, the random effects model will be used; otherwise, a fixed effects model will be used. The results of this systematic review will be published in a peer-reviewed journal. This systematic review will evaluate the clinical development of patients with conservatively monitored histologically confirmed HPV16/18+ CIN2.

Inflammatory cell response following ST-elevation myocardial infarction treated with primary percutaneous coronary intervention and its impact on cardiovascular outcomes: A systematic review and meta-analysis

BackgroundInflammatory responses post STEMI may mediate major adverse cardiovascular events (MACE). This is the first systematic review to map leukocyte response following a STEMI and its association with outcomes. MethodsWe systematically searched EMBASE and Medline for studies of STEMIs undergoing primary PCI. Eligible studies reported leukocytes or its subtype plus either 30-day and/or 1-year MACE. Random effects model for pooled proportions was used to estimate 30-day and 1-year mortality and MACE. Meta-regression was used to estimate the effect of leukocyte counts on cardiovascular outcomes. Publication bias was assessed using Egger’s regression-based test. The review was registered with PROSPERO (CRD42019124991). ResultsOf the 3,813 studies meeting the preliminary search criteria, 24 cohort studies were eligible for inclusion, representing 19,074 persons [76.4% male (n = 14,539); mean age 61.6 years]. Leukocytes had a mean of 10.5x109 (SD 4.7) on admission and 11.1x109 (SD 3.3) at day one post STEMI. Neutrophils increased day one post STEMI, while lymphocytes decreased. There was limited data on other leukocyte subtypes and beyond day one. Estimated 30-day and 1-year all-cause mortality were 6.5% (95% CI 4.8-8.2, p <0.001) and 9.7% (95% CI 5.6-13.8, p <0.001), while the estimated 30-day and 1-year MACE were 14.9% (95% CI 5.3-24.4, p < 0.001) and 15.2% (95% CI 7.2-23.2, p < 0.001). The meta-analysis was limited by a high degree of heterogeneity between studies. ConclusionsThis review highlights the urgent need to better characterise inflammation post STEMI to identify mediators for the persistently high mortality and morbidity associated with STEMI.

Neuropsychological profiles of children with agenesis of the corpus callosum: A scoping review.

To understand the wide variety of clinical outcomes in children with agenesis of the corpus callosum (AgCC) and examine evidence for the proposed neuropsychological syndrome reported in adults with primary AgCC. PsycINFO, PsycArticles, Medline, Embase, and Web of Science (January 2007-November 2021) were searched to identify studies reporting on cognitive or neuropsychological outcome in children with AgCC aged up to 18 years. Twenty-three articles investigating the cognitive profile were found; their methodology was evaluated against quality criteria. While there was a high degree of heterogeneity across studies, including the methodological quality, there was evidence for some features of the neuropsychological syndrome in children with AgCC. Vulnerabilities in executive function and social cognition were found, with particular difficulties on complex and novel tasks. Data on the neuropsychological outcomes in children with AgCC are limited. Broad assessments are necessary to determine the extent to which core features of the neuropsychological syndrome may characterize children with AgCC and how additional neuroanatomical features contribute to outcome.

A comprehensive assessment of runoff dynamics in response to climate change and human activities in a typical karst watershed, southwest China

The Chengbi River Basin is a typical karst watershed in Southwest China. Understanding the effects of climate change (CC) and human activities (HAs) on hydrological process is important for regional water resources management and water security. However, a comprehensive assessment of the effects of CC and HAs on runoff dynamics at different time scales in the Chengbi River Basin is still lacking. To address these needs, we used Budyko Mezentsev-Choudhurdy-Yang and Slope change ratio of accumulative quantity methods to assess the contribution of the changing environment to annual and intra-annual runoff changes in the Chengbi River Basin. The results indicated that annual runoff time series was divided into the base phase Ta (1980–1996) and the change phase Tb (1997–2019). Compared to the natural status in Ta, the relative contributions of CC and HAs to the runoff increase in Tb were 154.86% and −54.86%. In addition, the shift in intra-annual runoff occurred in 2007 and was mainly caused by HAs, with a contribution rate of 76.22%. The increase in annual runoff in Tb could be attributed to the positive contribution of rainfall. Changes in rainfall and reservoir construction altered the original state of intra-annual runoff. Furthermore, the high degree of heterogeneity in the surface karst zone increased the runoff coefficient. The spatial unsaturation of the subsurface water-bearing media and rainfall patterns caused a significant lag effect in the response of surface runoff to rainfall. This study can help researchers and policy makers to better understand the response of karst runoff to changing environment and provide insights for future water resources management and flood control measures.